Aging is often defined by stereotypes, but has an individual look and feel for every person. The changing demographics of American society should be leading to a stronger focus on the direction of social policy related to aging and older adults. Previous columns have summarized the views of certain current presidential candidates regarding Social Security and Medicare, which are two of the mainstays of aging in the U.S.
Policies affecting long-term care are not usually scrutinized as closely because most of us hope to never need long-term care services. Yet the National Center for Health Statistics reports that in 2016, more than 8.3 million people received these types of services through adult day centers, home health agencies, hospice agencies, nursing homes, and residential communities (https://www.cdc.gov/nchs/data/series/sr_03/sr03_43-508.pdf).
Since independence as we age is not guaranteed, it makes sense to consider long-term care policy proposals and how our own or the care needs of our loved ones will be met. Here are the highlights of the current top Democratic candidates’ platforms:
- Provide tax breaks for caregivers who are not receiving wages for their work which can be used toward building retirement savings
- Increase tax benefits for older Americans who utilize retirement savings to purchase long-term care insurance (LTCI)
- Support the passage of the CARE Act at the federal level. This Caregiver Advise, Record, Enable Act is designed to improve how discharge instructions are provided to caregivers when an individual is discharged from the hospital
- Provide a daily benefit for those over age 65 who need home or facility care to help them manage 2 or more activities of daily living. This benefit would be adjustable for inflation and the area in which a person lives
- Standardize LTCI, create a marketplace for these plans, encourage employers to offer this type of insurance, and design private/public partnerships to provide coverage
- Adjust state Medicaid reimbursement rates to allow for care providers to pay workers at least a $15/hr minimum wage
- Provide 12 weeks of paid leave for family caregiving
- Expansion of the CAPABLE program in which older adults are visited by a nurse, occupational therapist, and home repair professional in order to keep them safer and healthier in their homes
- Creation of an Intergenerational Service Corps to strengthen and increase the direct care workforce
- Set and enforce minimal staffing ratios in nursing homes and enact federal quality standards for assisted living facilities
- Provide Social Security credits for certain family and unpaid caregivers
- Increase wages and improve training for long-term care workers and provide a loan forgiveness program
- Increase access to mental health treatment for older adults
- Provide a tax credit of up to 20% of the premium cost of qualified LTCI plans
- Provide paid family leave and a tax credit for caregivers
- Invest in programs to care for those experiencing Alzheimer’s disease
- Offer incentives for employers to provide LTCI plans to employees
- Prevent disability and aging services from control by for-profit managed care organizations
- “Guarantee health care, including mental health care and home- and community-based services and supports without waitlists, asset or income restrictions, as a human right to everyone in America”
- Increase funding and expansion of programs which benefit vulnerable older adults
- Expansion and improved training for the direct care workforce
- Allow home care workers to organize and join unions
- Create direct care training and certificate programs to promote safety
- Enforce minimum federal nursing home staffing requirements
- Raise the federal minimum wage to $15/hour which could help attract and retain direct care workers
- Provide up to 12 weeks of paid family or medical leave in a one year period for any worker who meets the work history requirements for Social Security Disability Insurance. Workers would receive 66% of their salary, capped at $4,000 per month, with a minimum payment of $580 per month.
- Create a new Social Security credit for people who leave the workforce to care for a loved one
These proposals seek to address some of the major shortcomings of our present long-term care system: helping older adults afford care, providing additional financial security for family caregivers, and improving the shortage of direct care workers. Let’s hope that these concerns receive adequate attention from all politicians in the coming years. Republican, Democrat, or Independent, we are all aging.
For additional candidate policy proposals related to Social Security and Medicare, visit https://keystoneelderlaw.com/medicare/medicare-policy-presidential-hopefuls/ and https://keystoneelderlaw.com/aging/aging-considerations-and-presidential-hopefuls/
Karen Kaslow, RN, BSN